自拟生精通络方对梗阻性无精子症患者妊娠结局的影响及其机理初探

发布时间：2018-03-24 03:37

本文选题：生精通络方　切入点：左卡尼汀　出处：《山东中医药大学》2014年硕士论文

【摘要】：目的：本研究从梗阻性无精子症附睾液中精子活力及肿瘤坏死因子-α（TNF-α）、活性氧（ROS）水平等方面出发，观察自拟生精通络方对妊娠结局的影响和探讨可能的机制。方法：将2012年4月至2012年10月于山东中医药大学第二附属医院生殖中心行卵泡浆内单精子显微注射（ICSI）的100例梗阻性无精子症患者随机分成4组：分别为生精通络方组25例；左卡尼汀（阳性对照）组26例；安慰剂加生活干预组24例；生活干预组25例。生精通络方组服用生精通络方（日一剂，早晚分服）；左卡尼汀组服用左卡尼汀口服液（1.0g/次，3次/天）；安慰剂加生活干预组服用与生精通络方外观相似的安慰剂加生活干预治疗，生活干预组仅进行生活干预治疗；连续治疗30天为一个疗程，疗程结束后采集精液标本，，分别测定四组用药前后附睾液中肿瘤坏死因子-α（TNF-α）、活性氧（ROS）水平，以及附睾精子活力、形态，并采集精液当日行卵泡浆内单精子显微注射（ICSI），比较四组间PESA-ICSI的获卵数、受精数、受精率、优质胚胎数、优质胚胎率和妊娠率。结果： 1.治疗前后精子活力指标的组内对比：生精通络方组的a级精子活动率（P=0.00040.01），b级精子活动率(P=0.04560.05）和精子活动率（P=0.00530.01.）同治疗前相比均有提高，左卡尼汀组的a级精子活动率(P=0.00010.01）,b级精子活动率（P=0.00970.01）与精子活动率（P=0.00510.01）同治疗前相比均有显著提高，其余两组各项指标的变化均无统计学意义。 2.治疗前后生精通络方组和左卡尼汀组附睾液中肿瘤坏死因子-α（TNF-α）（P=0.00000.01）、活性氧（ROS）水平（P=0.00000.01）同治疗前相比均有显著降低，其余两组附睾液中各项指标变化均无统计学意义。 3.治疗前后四组间获卵数、受精数和受精率无显著性差异（P＞0.05）。生精通络方组和左卡尼丁组获得优质胚胎数及优质胚胎率明显高于其余两组(P0.01),有统计学意义。四组间妊娠率无显著性差异（P＞0.05）。结论：证实梗阻性无精子症患者附睾液中TNF-α和ROS，与精子活力尤为相关。生精通络方可以通过下调附睾液中TNF-α和ROS水平，从而改善附睾环境，并能增强精子活力和受精能力，从而改善ICSI妊娠结局。
[Abstract]:Objective: to observe the effect of Shenjingtongluo recipe on pregnancy outcome in the epididymal fluid of obstructive azoospermia from the aspects of sperm motility and tumor necrosis factor- 伪 TNF- 伪, reactive oxygen species (Ros). Methods: from April 2012 to October 2012, 100 patients with obstructive azoospermia received intracytoplasmic intracytoplasmic sperm microinjection (ICSII) in the Reproductive Center of the second affiliated Hospital of Shandong University of traditional Chinese Medicine were randomly divided into 4 groups: 25 patients in the group of living and mastering the collateral; Leucarnitine (positive control) group (n = 26); placebo plus life intervention group (n = 24); life intervention group (n = 25). In the morning and evening, the patients in the leucarnitine group were treated with 1. 0 g of levacarnitine oral liquid three times a day, the placebo plus life intervention group were treated with placebo and life intervention which were similar in appearance to Shengjing Tongluo recipe, and the life intervention group was only treated with life intervention. Semen samples were collected after 30 days of continuous treatment. The levels of tumor necrosis factor- 伪 -TNF- 伪, reactive oxygen species (Ros), sperm motility and morphology of epididymal sperm were measured before and after treatment in the four groups. Semen was collected and intracytoplasmic intracytoplasmic sperm microinjection (ICSI) was performed to compare the number of PESA-ICSI eggs, fertilization, fertilization rate, number of high-quality embryos, high quality embryo rate and pregnancy rate among the four groups. Results:. 1. Intra-group comparison of sperm motility indexes before and after treatment: the sperm motility rate of the Shenjingtongluo prescription group was higher than that of the pre-treatment group. The motility rate of spermatozoa was 0.04560.05) and the sperm motility rate was 0.00530.01.Compared with that before treatment, the sperm motility rate of the Shenjingtongluo prescription group was higher than that of the control group before and after treatment. The sperm motility rate of levocarnitine group was significantly higher than that of control group (P < 0. 00010.01). The other two groups had no statistical significance in the change of the other two groups' sperm motility rate (P < 0. 00010. 01) and the sperm motility rate (P < 0. 00510. 01). 2. Before and after treatment, the levels of TNF- 伪 TNF- 伪 TNF- 伪 TNF- 伪 TNF- 伪 TNF- 伪 and Ros in the epididymal fluid of Shengjingtongluo recipe group and leucarnitine group were significantly lower than those before and after treatment, but there were no significant changes in the other two groups in the epididymal fluid. 3.The number of eggs obtained between the four groups before and after treatment, There was no significant difference in fertilization number and fertilization rate (P > 0.05). The number of high-quality embryos and the rate of high-quality embryos in Shengjing Tongluo recipe group and levacarnitine group were significantly higher than those in the other two groups (P > 0.05), and there was no significant difference in pregnancy rate among the four groups (P > 0.05). Conclusion: TNF- 伪 and ROSin the epididymal fluid of patients with obstructive azoospermia are particularly related to sperm motility. Shengjingtongluo prescription can improve the environment of epididymis by down-regulating the levels of TNF- 伪 and ROS in epididymal fluid, and can enhance sperm motility and fertilization ability. In order to improve the pregnancy outcome of ICSI.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R698.2

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